Loading...
HomeMy WebLinkAboutWater Softner 13-1378 I 0 O>< A n t n n■ / A \ 21 0 2 0 0 00 0000 ca ro R /�A7ƒJ 3 0 E0 PIO k m �Z �/ z $� § § .2z z 0 o t J > . 0 � 0 z z 1 .. 0 J i z g g m � � 0 77 73 Al m z 0 6 � m g .. • 2 2 2 2 \► / J $ f ° ° 000000 0 e J MV ft C •12 0 _ ? \$$m.w m.© ■ pZn t r- 8/ a 1 x 0 k m zx z c P 73 0 r„ P +4 m < o @ z m N Z tiieg 0000 ` PI 2 � z . _ mv, mml 00 g f ■ 7 . . . . r 61 § M F 5 k A y • • N 4 YR/0 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT oel e F i 1 e PERMIT NO. /3 - /3 7y cit 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 51.21 N om s4 ss37 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Phone ) (Ja - 99n -yyq,5 (Name) � r 61 r c,. %.-1/4-n %.-1/4-n -�. (Address) APPLICANT CULLIGAN WATER CONDITIONING (Name) 6030 CUJLLIGAN WAY (Phone) MINNETONKA, MN 55345 (Address) (952) 933 -72n0 (Address) (City) (Zip Code) (Contact Person) , • 1 (Phone) APPLICANT SIGNATURE :..i DATE 1 c - y — (3 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough -ins Dishwasher Water Heater Floor Drain Water Softener Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet (Toilet) Other FEE SCHEDULE The Minnesota Statutes § 326B.148 of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50 SURCHARGE" has been extended Residential, Additions & Alterations $49.50 The minimum surcharge for a "fixed fee" permit is $5.00 t $ Building Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ 5114 TOTAL PERMIT FEE $ ,S y 56 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid -a Receipt No. 7d,6 Date /2/1 743 By Building Ofikcfal Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 • 3. ; a